Facts about Scabies and Aid Orphans

Scabies is an infestation of the skin with the microscopic mite Sarcoptes scabiei. Infestation is common, found worldwide, and affects people of all races and social classes. Scabies spreads rapidly under crowded conditions where there is frequent skin-to-skin contact between people.

The impact on aid orphans is enormous, with their weakened immune system they are at risk for a more severe form of scabies, called Norwegian or crusted scabies.

The mites that cause scabies burrow into the skin and deposit their eggs, forming a characteristic burrow that looks like a pencil mark. Eggs mature in 21 days. The itchy rash is an allergic response to the mite.

Mites may be more widespread on a baby’s skin, causing pimples over the trunk, or small blisters over the palms and soles. In young children, the head, neck, shoulders, palms, and soles are involved. In older children and adults, hands, wrists, genitals, and abdomen are involved.

Norwegian scabies (crusted scabies)

Norwegian scabies (crusted scabies) in a patient with acquired immunodeficiency syndrome.

Hyperinfestation occurs with thousands or millions of mites. A diffuse, non-itching, erythematous, macular rash is seen. Initially, it may be attributed to a drug rash. Then, a progression hyperkeratoic plaques is observed. Bacteremia frequently occurs in AIDS patients with scabies.

The human itch mite, Sarcoptes scabiei and an egg are seen in a wet mount preparation.

Burrows should be sought and unroofed with a sterile needle or scalpel blade, and the scrapings examined microscopically for the mite, its eggs and its faecal pellets.

Herpes Zoster

This condition is seen in 10 to 20 percent of patients with HIV infection. Lesions consist of vesicles with ulceration, which heal but leave a permanent scar. It is often the first clinical indication of immunodeficiency.

Herpes simplex virus (HSV) infection

Shallow ulcers in the perianal region of a patient with herpes simple virus infection.

As HIV disease progresses and the CD4+T cell count declines, these infections become more frequent and severe, especially in perianal and genital regions. Lesions often appear beefy red, extremely painful and have a tendency to recur. HSV should be included in the differential diagnosis in a patient with HIV infection and poorly healing and painful perianal lesions.

Kaposi’s sarcoma

Purplish macular-nodular lesions of varying sizes in a patient with Kaposi’s sarcoma.

Kaposi’s sarcoma may present in a variety of ways and may be seen at any immunological stage of HIV infection, even in the presence of a normal CD4+T cell count. It is a multicentric neoplasm consisting of multiple vascular nodules appearing on the skin, mucous membranes and viscera. In 10 to 15 percent of cases, oral cavity is initially affected

Seborrhoeic dermatitis

Red scaly rash or erythematous, dermatitis-like lesions involving the nasolabial fold and perioral area.

Lesions may spread to face and scalp and sometimes cover the whole body. The rash is itchy and affects face, neck, groin and axillae. It is called “seborrhoeic”, although the term refers more to the appearance of the distribution of the rash than to the cause. Sometimes there are scales and papules or pustules. Seborrhoeic dermatis may be difficult to distinguish from psoriasis. Seborrhoeic dermatitis is comm. In patients with HIV. Dermatitis tends to become more severe and scales thick with progressive immunosuppression.

Psoriasis

The lesions are characterized by erythematous plaques of varying sizes with adherent silvery scales. Psoriasis may be particularly severe when it occurs in HIV infection. Pre-existing psoriasis may become guttate in appearance and more refractory to treatment.